4种肿瘤标志物对上皮性卵巢癌定性诊断价值的初步研究

目的：探讨多胺（ＰＡ）、ＣＡ１２５、ＣＡ１５．３和ＣＡ１９．９在定性诊断上皮性卵巢癌中的价值。方法：应用ＨＰ％Ｍ高效液相色谱仪和ＨＰ１０４０Ａ荧光检测器或酶联免疫吸附法测定上皮性卵巢癌４０例和卵巢良性肿瘤１８例血清中ＰＡ、ＣＡ１２５、ＣＡ１５．３和ＣＡ１９．９水平。结果：４种标志物中，ＰＡ诊断卵巢癌的敏感性、阳性预测率、阴性预测率和预测准确率最高，其次是ＣＡ１２５。结论：ＰＡ对人类恶性肿瘤缺乏特异性，但可作为鉴别卵巢良、恶性病变的有价值标志物。联合测定ＰＡ和ＣＡ１２５时，其敏感率为９４．９％。因此，联合测定ＰＡ和ＣＡ１２５可作为筛查卵巢良、恶性肿瘤的方法。     

应用尿半胱氨酸蛋白酶活性测定诊断妇科恶性肿瘤的价值

对恶性肿瘤７０例（恶性组）、良性肿瘤５０例（良性组）和正常健康妇女５０例（对照组）尿中半抗氨酸蛋白酶（ＵＣＰ）活性进行测定。结果：ＵＣＰ辅助诊断恶性肿瘤的敏感性为９０％、特异性为８０％、准确性为８６％。恶性组ＵＣＰ值明显高于良性组和对照组（Ｐ＜０．０１）。ＵＣＰ检测对卵巢癌尤为敏感，敏感性为９５％，高于子宫体癌（７７％）、宫颈癌（８５％）。ＵＣＰ、血清肿瘤标记物ＣＡ＿（１２５）及乳酸脱氢酶（ＬＤＨ）同功酶辅助诊断卵巢癌的敏感性依次为９０％、８５％、７５％；特异性为８０％、８７％、８５％；准确性为８４％、８４％、８０％。ＵＣＰ与ＣＡ＿（１２５）对卵巢癌的辅助诊断有同样的价值，而且优于ＬＤＨ同功酶。８例卵巢癌Ⅰ期患者，７例ＵＣＰ值异常，而同组６例卵巢癌Ⅰ期患者中，无１例ＣＡ＿（１２５）值异常，说明ＵＣＰ检测对早期卵巢癌较ＣＡ＿（１２５）更敏感。提示：ＵＣＰ可能成为妇科恶性肿瘤，特别是卵巢癌的标记物。     

应用多项肿瘤标记物检测卵巢恶性肿瘤的研究

目的为了提高卵巢恶性肿瘤诊断的特异性及敏感性,加强术后患者的病情追踪。我们应用５项肿瘤标记物ＳＡ,ＬＳＡ,ＣＡ１２５,ＣＰ２,６Ｂ１１Ａｂ２进行临床观察。方法对６７例卵巢恶性肿瘤及３３例卵巢良性肿瘤患者进行血清检测,以３８例正常妇女进行对照。结果单纯应用ＣＡ１２５诊断卵巢恶性肿瘤的敏感性及特异性分别为８３６％及８５９％,而５项肿瘤标记物中以任意３项及３项以上阳性为标记物诊断阳性时,检测卵巢恶性肿瘤的敏感性及特异性分别为８６６％及９４４％。临床Ⅰ、Ⅱ期患者的５项肿瘤标记物联合检测的特异性及敏感性,较ＣＡ１２５单项检测有明显提高。结论５项肿瘤标记物联合检测,对提高卵巢恶性肿瘤诊断的准确性及术后监测有一定意义     

CA125与子宫内膜异位症的关系

ＣＡ１２５是一种血清抗原，普遍认为是上皮性卵巢癌的肿瘤标志物，８０年代中后期发现它与子人膜异位症也密切相关。子宫内膜异位病患者血清ＣＡ１２５水平较正常妇女高，在Ⅲ－Ⅳ期患者差异更大。对诊断子宫内膜异位症有一定价值。     

血清CA_(125)测定及宫腔声学造影诊断子宫腺肌病

目的：探讨血清 Ｃ Ａ１２５ 测定及宫腔声学造影诊断子宫腺肌病的价值。方法：对经术后病理检查证实的３１ 例子宫腺肌病（ 腺肌病组） 和２９ 例子宫肌瘤（ 肌瘤组） 患者,术前采用免疫放射法测定血清 Ｃ Ａ１２５ 水平, 并用３ ％ 双氧水行宫腔声学造影检查。１２ 例正常妇女为正常对照组。结果：三组血清 Ｃ Ａ１２５ 阳性率分别为８７ ．１ ％ 、１０ ．３ ％ 、８ ．３ ％ ,均值（ 珋ｘ ±ｓ） 分别为１０５ ．７１ ±６８ ．８２ｋ Ｕ／ Ｌ、１３ ．１４ ±１２ ．９９ｋ Ｕ／ Ｌ、１１ ．８３ ±９ ．９１ｋ Ｕ／ Ｌ。腺肌 病组 Ｃ Ａ１２５ 阳性 率及均值均 明显高于 其他两 组（ Ｐ＜ ０ ．０１） 。宫腔双氧水造影显示,２４ 例腺肌病病人阳性率为７７ ．４２ ％ , 而肌瘤组和对照组均为阴性结果。两种方法结合分析, 敏感性可提高至９６ ．７７ ％ , 准确性提高至９３ ．０５ ％ 。结论：血清 Ｃ Ａ１２５ 测定及宫腔双氧水造影对于子宫腺肌病有辅助诊断价值,两者结合应用,能提高诊断的准确性。     

肿瘤标记物联合检测对卵巢恶性肿瘤的诊断价值

应用放免及生化法对１０７例卵巢肿瘤患者及５０例正常健康妇女血清ＳＦ（铁蛋白）、β２－ＭＧ（β２－微球蛋白）、ＣＥＡ、ＬＤＨ、ＡＦＰ和β－ｈＣＧ进行定量检测。结果表明：①卵巢恶性肿瘤组血清ＳＦ、β２－ＭＧ、ＣＥＡ及ＬＤＨ含量均显著高于卵巢良性肿瘤组及正常对照组（Ｐ＜０．０１）；ＳＦ含量与肿瘤分期呈正相关，随卵巢恶性肿瘤临床期别增高而递增。ＡＦＰ、β－ｈＣＧ含量在卵巢良、恶性肿瘤组间及正常对照组间均无显著差异，提示血清ＳＦ、β２－ＭＧ、ＣＥＡ和ＬＤＨ检测，对卵巢恶性肿瘤的诊断及卵巢良、恶性肿瘤的鉴别诊断有一定临床意义。②ＳＦ、β２－ＭＧ、ＣＥＡ及ＬＤＨ诊断卵巢恶性肿瘤的准确性分别为７９．４４％、６９．１６％、６５．４０％及５６．０７％，四项联合准确性可提高到８３．１８％，提示：联合检测可提高临床诊断价值，优于单项检测结果。联合检测并结合病史及临床检查，可作为卵巢癌的初筛检查。     

应用~99m锝标记抗癌胚抗原单克隆抗体行卵巢肿瘤放射免疫显像的研究

应用放射性核素锝（￣（９９ｍ）Ｔｃ）标记抗癌胚抗原（ＣＥＡ）单克隆抗体（ＭｃＡｂ）放射免疫显像（ＲＩＩ），对１３例卵巢恶性肿瘤、４例卵巢癌手术、化疗后无复发的病人以及１３例卵巢及盆腔内其他良性病变的病人，在注射标记抗体后第１８、２４小时进行盆腹腔前后位平面显像观察。结果：卵巢恶性肿瘤ＲＩＩ的阳性检出率为１００％（１３／１３），卵巢癌手术、化疗后无复发和卵巢及其他良性病变的阴性预测率为９４％（１６／１７），肿瘤转移灶的检出率为６３％（１０／１６）。提示：￣（９９ｍ）Ｔｃ－ＣＥＡ－ＭｃＡｂ的ＲＩＩ对卵巢恶性肿瘤的定性、早期诊断有一定意义。     

卵巢上皮性肿瘤组织中CA125的定位测定

卵巢上皮性肿瘤组织中ＣＡ＿（１２５）的定位测定邓晓谷，叶启文，彭真年本研究以卵巢癌抗原ＣＡ＿（１２５）的单克隆抗体ＯＡ＿（１２５）及免疫组化ＡＢＣ法，对１４１例各型卵巢上皮性肿瘤组织中ＣＡ＿（１２５）进行定位测定，了解浆液性囊腺癌组织ＣＡ＿（１２５）...     

术前测定血清CA125,CA19.9,CA72.4,CEA和GM—CSF在鉴别附件包 …

目的：探讨术前测定２血清ＣＡ１２５、ＣＡ１９．９、ＣＡ７２．４、ＣＥＡ和ＧＭ－ＣＳＦ水平在鉴别附件包块良恶性质中的作用。方法：７４例附件包块患者术前１周内采外周血，用固相免疫放射法测定各种肿瘤标志物浓度，并与术后组织学诊断比较。计算各标志物单独和联合应用诊断卵巢癌的相应诊断系统。结果：（１）ＣＡ１２５（临界什７０Ｕ／ｍｌ）鉴别卵巢肿瘤性质的敏感性和特异性分别为８５．７１％和８２．６１％，ＣＡ１９．     

妊高征患者红细胞膜ATP酶活力和细胞内离子水平的变化

测定２０例正常未孕妇女，２５例正常孕妇和３０例妊高征患者红细胞膜ＡＴＰ酶活力和红细胞内离子水平。结果：妊高征患者Ｎａ￣＋－Ｋ￣＋－ＡＴＰ酶、Ｃａ￣（＋＋）－ＡＴＰ酶活力明显低于未孕妇女和正常孕妇，Ｍｇ￣（＋＋）－ＡＴＰ酶活力无明显改变；妊高征患者红细胞内Ｎａ￣＋、Ｃａ￣（＋＋）明显高于未孕妇女和正常孕妇，Ｍｇ￣（＋＋）明显低于正常未孕妇女和孕妇，Ｋ￣＋无明显变化。研究结果提示红细胞膜ＡＴＰ酶活力和细胞内离子水平异常与妊高征的发生和发展有关。     

Intracystic evaluation of tumor markers in benign and malignant ovarian pathology

OBJECTIVE: To evaluate, in patients with benign and malignant ovarian cysts, serum samples and ovarian intracystic fluids for the presence of tumor markers such as CA 125, CA 15.3, tissue polypeptide antigen (TPA), CA 19.9 and the carcinoembryonic antigen (CEA). MATERIAL AND METHOD: We studied overall 64 patients with ovarian pathology. Sixteen patients were affected by functional cysts, 28 women by benign cystic tumors and 20 by cystoadenocarcinomas. RESULTS: Average serum levels of all but CA 15.3, TPA and CEA tumor markers of benign cystic ovarian tumors were higher than those of functional cysts. All but CA 19.9 mean intracystic fluid markers levels were more elevated in benign tumors than in functional cysts. In patients with malignant cystic tumors, all but CEA mean serum marker levels were higher than those of benign tumors; furthermore even all mean intracystic levels of markers were more elevated than those of benign tumors. CONCLUSION: This study confirmed the high positivity of tumor markers such as CA 125, CA 15.3, TPA, CA 19.9 and CEA in both the serum and intracystic fluid of patients with malignant epithelial ovarian tumors.     

Relation between serum levels of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA125) and their immunohistochemical identification in benign and malignant gynecological disease

Summary We studied immunohistochemical stains for TPA and CA125 in patients with benign and malignant gynecologic diseases. The results were as follows: (1) CA125 was not found in ovarian mucinous cystadenocarcinoma but was demonstrated immunohistochemically in 82% of ovarian serous cystadenocarcinomas and 83% of Krukenberg's tumors. (2) TPA was demonstrated in 65% of ovarian serous and 75% of ovarian mucinous cystadenocarcinomas, and in 58% of endometrial carcinomas. (3) TPA was found in all trophoblastic tumors examined, while CA125 was found in none. Eighty-three percent of patients with trophoblastic diseases had raised serum TPA levels. (4) When serum CA125 levels were raised, CA125 was demonstrated immunohistochemically in 71% of patients with ovarian serous cystadenocarcinomas, 67% of patients with Krukenberg's tumors and 100% of patients with tubal carcinomas. (5) Despite elevated serum levels, CA125 and TPA were not identified by immunohistochemistry in 64% cases of benign ovarian disease and in 80% of patients with uterine myomata. (6) It would seem that CA125 was more easily released from tumor cells than TPA.     

Evaluation of seven different tumour markers for the establishment of tumour marker panels in gynecologic malignancies

Seven tumour markers, i.e. squamous cell carcinoma antigen (SCC), cancer antigen 125 (CA 125), tissue polypeptide antigen (TPA), neopterin, C-reactive protein (CRP), carcinoembryonic antigen (CEA) and deoxythymidine kinase (TK) were analysed in sera from 104 women with benign and 61 women with malignant gynecologic diseases, in order to create tumour marker panels for various gynecologic malignancies, for monitoring and prediction of disease development. The incidence of elevated tumour marker levels, in cervical carcinoma was 78% when SCC, CA 125 and CEA were used. In ovarian carcinoma one of the markers CA 125, TPA and CEA was elevated in 91% and for endometrial carcinoma the best combination of markers was SCC, CA 125 and CEA (57%). No individual marker was superior to the above combinations. However, in patients with a fatal outcome of their malignant gynecologic disease (mean survival time from serum sampling was 16 months), the incidence of death was highest among those who had TPA elevated (91%) followed by neopterin (86%) and CRP (76%). Although intercurrent diseases affected tumour marker levels the markers picked up a majority of patients with a poor prognosis. This demonstrates the importance of interpreting tumour marker results against a background of detailed clinical information.     

Evaluation of HE4 as an extrabiomarker to CA125 to improve detection of ovarian carcinoma: is it time for a step forward?

Purpose

To evaluate human epididymis protein 4 (HE4) as an extrabiomarker to cancer antigen 125 (CA125) to improve the detection of ovarian carcinoma.

Methods

Sixty patients with ovarian carcinoma, 50 patients with benign ovarian tumors and 30 healthy women were included in the present study. Serum concentration of HE4 was assayed using ELISA technique, while CA125 was assayed using chemiluminescent enzyme immunoassay.

Results

The median CA125 and HE4 serum values were significantly higher among ovarian cancer patients when compared with healthy control However, the median serum levels of CA125 but not HE4 were significantly higher among patients with benign ovarian tumors as compared to healthy women. Based on the receiver operator characteristics curve analysis, HE4 had higher sensitivities than CA125 for the detection of ovarian cancer at 90, 95 and 98 % specificities and the combination of both markers yielded a higher sensitivity than either alone. However, CA125 but not HE4 had higher sensitivities for the detection of benign ovarian tumors at the same specificities. In addition, a positive correlation was observed between HE4 and CA125 among patients with ovarian carcinoma.

Conclusion

HE4 is a valuable marker for ovarian cancer diagnosis and when combined with CA125, they had a higher sensitivity at a set specificity, thus providing a more accurate predictor of ovarian cancer than either alone.     

Serum levels of six tumor markers in patients with benign and malignant gynecological disease

Summary We studied the pretreatment serum levels of 6 tumor markers in gynecological patients with and without malignant disease. The tumor markers were carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin, Schwangerschaftsprotein 1 (SP₁), Schwangerschaftsprotein 3 (SP₃) and cancer antigen 125 (CA125). The results were as follows: (1) Serum CA125 and TPA levels were raised in 81% and 57% of patients with ovarian serous cystadenocarcinoma: CEA and SP₃, in 52% and 43% respectively of patients with ovarian mucinous cystadenocarcinoma; CA125, TPA and SP₃, in 76%, 48% and 48% respectively of patients with other ovarian malignancies; and TPA and SP₃, in 56% and 40% respectively of patients with endometrial carcinoma. (2) Serum levels of TPA, ferritin and CA125 were more often raised with advancing stages of malignant disease. (3) Serum TPA levels were elevated in 55% of patients with stage I endometrial carcinoma, and serum SP₃ levels were elevated in 35% of patients with a stage I malignant ovarian neoplasm and in 45% of patients with endometrial carcinoma. (4) One of the 6 tumor markers showed a raised level in 84% of patients with gynecologic malignancy as against 56% in those with benign gynecologic diseases.     

Clinical usefulness of sialyl SSEA-1 antigen as tumor marker for ovarian cancer as compared with CA125, CA19-9, TPA, IAP, CEA and ferritin

In order to determine the clinical significance of sialyl SSEA-1 antigen, we compared its usefulness as a tumor marker for ovarian cancer with simultaneously measured CA125, CA19-9, TPA, IAP, CEA and ferritin. The sialyl SSEA-1 antigen in serum was measured by radioimmunoassay with an "FH-6" Otsuka Kit. The immunohistochemical localization of sialyl SSEA-1 antigen in ovarian carcinoma tissues was determined by an immunoperoxidase method using FH-6 monoclonal antibody. Among fifty-one patients with ovarian cancer, the incidence of elevated serum levels was 54.9% with sialyl SSEA-1 antigen, 90.2% with CA125, 48.8% with CA19-9, 78.0% with TPA, 73.1% with IAP, 17.1% with CEA and 63.4% with ferritin. On the other hand, among the patients with uterine malignancies and gynecologic benign tumors, the incidence of elevated sialyl SSEA-1 antigen levels in serum was lower than that of other tumour markers. In the patients with ovarian cancer, the serum levels of sialyl SSEA-1 antigen increased in accordance with the advance of the clinical stage and were also correlated with the effect of therapy. In the examination of immunohistochemical localization of sialyl SSEA-1 antigen, a positive reaction occurred in 10 out of 30 ovarian carcinoma specimens. Intense staining appeared in the secretory materials, in the luminal surface of the glands, and in the cytoplasm of cells. Thus, sialyl SSEA-1 antigen appears to be a useful tumor marker for the diagnosis of ovarian cancer, especially when measured simultaneously with CA125, CA19-9, TPA, ferritin and IAP.     

LPA、CA125与经阴道彩色多普勒超声联合诊断卵巢上皮癌的临床价值

目的:探讨血浆溶血磷脂酸(LPA)在卵巢上皮癌患者血浆中的表达水平,及其与血清CA125和经阴道彩色多普勒超声(TV-CDUS)联合应用诊断卵巢上皮癌的临床价值。方法:术前检测卵巢上皮癌48例,卵巢良性肿瘤30例的LPA、CA125,以20例健康者作为对照,卵巢肿瘤患者同时经阴道超声评分和TV-CDUS检查。结果:卵巢癌患者LPA水平明显高于卵巢良性肿瘤组和健康对照组,差异有统计学意义(P0.05),LPA水平在良性肿瘤组与健康对照组之间无显著差异(P0.05)。单独应用LPA、CA125、TV-CDUS检测诊断卵巢癌的敏感性和特异性分别为87.5%、79.16%、81.25%和80%、70%、86%,各组间敏感性和特异性比较,无显著差异(P0.05)。LPA、CA125、TV-CDUS 3项联合检测诊断卵巢癌的敏感性和特异性为95.80%和94%,与单独应用CA125检测特异性比较,差异有统计学意义(P0.05)。LPA诊断卵巢癌的敏感性和特异性与卵巢癌分期和病理类型无关(P0.05),CA125诊断卵巢癌的敏感性和特异性与卵巢癌的分期和病理类型有关(P0.05)。结论:卵巢上皮癌患者血浆LPA水平明显升高,有望成为卵巢上皮癌诊断的敏感指标,联合检测血浆LPA、血清CA125与TV-CDUS有助于术前卵巢癌的诊断。     

Macrophage-colony stimulating factor and ovarian cancer]

BACKGROUND: In this study the use of macrophage-colony stimulating factor (M-CSF) as tumor marker for ovarian cancer is evaluated. METHODS: Serum samples were obtained from 74 patients, 43 of these were affected by ovarian carcinoma and 31 by benign ovarian tumors. The M-CSF levels were assayed with an ELISA method and compared with those of 148 healthy women. CA 125 levels were also evaluated. RESULTS: In healthy women the M-CSF levels were 770.4 +/- 145.9 U/ml, the upper limit of normal level was considered 1056 U/ml. Serum M-CSF levels were significantly high in patients with ovarian cancer (1425.3 +/- 1007.1 U/ml; p < 0.001) and in 29 of the 43 patients exceeded the limit of 1056 U/ml. No differences were observed among the histologic types. There were no significant differences between patients with benign ovarian pathology and healthy women. No definite relationship was found with CA 125, but evaluating at the same time M-CSF and CA 125 positive results were found in 95.3% of cases. CONCLUSIONS: Therefore M-CSF can be considered a marker for ovarian cancer, and the assay of its serum levels can be particularly useful in association with those of CA 125.     

恶性肿瘤特异性生长因子在卵巢肿瘤中的临床应用价值

目的探讨血清恶性肿瘤特异性生长因子(TSGF)在卵巢恶性肿瘤的诊断及疗效监测中的临床应用价值。方法使用TSGF快速诊断试剂盒,对170例患者的196份血清进行检测,其中69例为卵巢恶性肿瘤,18例卵巢交界性肿瘤,42例卵巢良性肿瘤,41例盆腔良性病变;同时取20例正常妇女血清标本作为对照。所有标本同时检测CA125。结果卵巢恶性肿瘤组血清TSGF阳性率明显高于其他各组(P<0.01)。晚期肿瘤的血清TSGF诊断敏感性高于早期(P<0.05)。卵巢高分化恶性肿瘤及交界性肿瘤血清TSGF敏感性明显低于中、低分化组(P<0.01)。TSGF诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,CA125为73.9％和55.4％,二者差异无显著性(P>0.05)。TSGF+CA125联合检测诊断卵巢恶性肿瘤的敏感性为87.0％,较TSGF、CA125单项检测敏感性明显提高(P<0.05),治疗前后血清TSGF水平下降不明显(P>0.05)。TSGF对卵巢恶性肿瘤的疗效监测价值似乎不大。结论 TSGF测定诊断卵巢恶性肿瘤的敏感性和特异性分别为78.3％和48.2％,其水平与细胞分化、临床分期有关。TSGF和CA125联合检测可明显提高卵巢恶性肿瘤的检出率,但TSGF对卵巢恶性肿瘤的疗效监测似无明显临床价值。     

Clinical use of CA 125 and its combination assay with other tumor marker in patients with ovarian carcinoma

The serum levels of CA 125 and CA 19-9 were determined by an immunoradiometric assay employing the monoclonal antibody OC 125 and anti-CA 19-9 antibody in 88 patients with ovarian carcinoma. When a cut-off value of CA 125 was set below 35 U/ml in the control group, serum elevated levels of CA 125 were found in 86.7% of the patients with surgically demonstrable ovarian serous cystadenocarcinoma, in 100% (4/4 cases) of clear-cell carcinoma, in 50% (2/4 cases) of endometrioid carcinoma, in 100% (5/5 cases) of undifferentiated carcinoma, and in 80% of the recurrent cases. Using a cut-off value of 37 U/ml, serum elevated levels of CA 19-9 were detected in 68.2% of mucinous cystadenocarcinoma, in 28.9% of serous cystadenocarcinoma, in 75% (3/4 cases) of metastatic ovarian carcinoma, and in 37.5% of the recurrent cases. A statistical analysis of the combination assay using CA 125, CA 19-9, tissue polypeptide antigen (TPA), immunosuppressive acidic protein (IAP), ferritin and CEA was carried out by multivariate method (discriminatory analysis) in 45 patients with ovarian carcinoma and 50 healthy subjects. As a result before treatment, positive rates of a single tumor marker were 79.7% with CA 125, 42.7% with CA-19-9, 73.1% with IAP, 61.7% with TPA, 64.3% with ferritin and 25.4% with CEA, respectively. A combination assay of these markers was useful for detecting identification of ovarian carcinoma, by which it gave a higher accuracy of ovarian cancer detection.